The Common Sense Guide to Improving Palliative Care > Preventing, Assessing, and Treating Pain > 4.5 Measuring Success

Sick To Death book cover This extract from the online edition of The Common Sense Guide to Improving Palliative Care is used with permission.

Measuring Success

Whatever your aim, three basic measures can be used in the rapid-cycle process: outcome, process, and adverse effects (also see Chapter 2). For example, Team Faith's outcome measures included pain levels below the patient's own target. For you, process measures might include routine assessment or rapid response time. And adverse-effect measures should be monitored for trouble that stems from your changes (e.g., constipation or delirium).

Decide which data to collect, who will collect it and when, and how and whether to sample the population. Depending on the number of patients with which you are dealing, you may not have enough time to look at every record or patient. Instead, you will need a sampling plan. You also need to decide how often to display your data: weekly, monthly, or quarterly. Be sure to collect enough data to build a case (or to monitor when an improvement is not working).

Team Faith

Once Team Faith had invited key players to join them and had agreed on an aim, they worked out the specifics of how to measure whether their efforts were making a difference.

Measure: Percentage of cancer patients admitted to hospice with pain on their health problem list, who live the rest of their lives with no period longer than eight hours with pain worse than their personal goal.

If you look closely at Team Faith's aim statement, the measure is closely linked to the aim (see above).

Take note of the following specific reasons that are the basis of the aim:

Sometimes, collecting data on outcome measures alone is not enough, or it is not possible. You may need to look at the process itself and collect data to check that it is working.

Team Faith

Team Faith decided to start off measuring one process and one adverse effect.

Process measure: Percentage of cancer patients with the patient's target level and their current level of pain recorded with initial vital signs.

Adverse-effect measure: Percentage of cancer patients with opioid medications for whom a successful bowel regimen is continued or a new or improved one started.

Pain improvement teams can choose from many outcomes to measure progress. The following ideas should inspire you to think about what is important in your environment:

Following are some sample measures for improving pain treatment:

Process Measures

Outcome Measures

Adverse-Effect Measures

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